Thursday, January 29, 2009

Health in the news: Discussion

Recently David Rothman published a post in which he talked about "sites that critique journalism." These sites exist in order "to fill the information gap which can arise from:

confusion caused by media reports on the publication of new scientific studies relating to the same medical area, but with contradictory conclusions;

inaccuracies in some media reporting caused by - difficulties in communicating complex medical information to a non-medical audience; over-zealous sub-editing to make news items/articles 'fit to size' and the issuing of press releases, by medical journals, which may not always report limitations in newly published studies - leading to further miscommunication of information;

a reluctance from some doctors to speak to the media, due to perceptions within the medical profession that doctors may be misrepresented or misunderstood;

public perceptions that 'official' medical or scientific advice may be influenced by policy matters; and

I've being thinking about this a lot lately and have been meaning to write about it. My particular peeve has to do with the fact that news articles rarely, if ever, cite their sources. Articles in the news will at most mention in passing that such and such study was published in the October issue of the New England Journal of Medicine. The researcher's names are usually mentioned.

That is enough information for me to find the article, but is it enough for the lay person? Since a big part of my job is teaching health professionals how to find articles they sometimes have difficulty finding when they have the complete citation and access to McGill's full complement of journals and databases, I suspect that it is not enough for your average person reading the paper.

It took me half an hour of skilled digging to find the research discussed in this article a friend recently posted to Facebook: Surrounded by friends? It's all in your genes. Eventually "...I was able to find out that it was published in the Proceedings of the National Academy of Sciences in the Early edition ("published online before print January 26, 2009") which is available by subscription only- the copy I have linked to here is not the final published draft."*

An Unsatisfactory story may:• Fail to identify the source of the story (news release, journal article, editorial, scientific meeting presentation, etc.) and fail to make obvious the extent to which that source is likely to be conflicted... (Health News Review: About us, retrieved 29 Jan. 2009)

Media Doctor.ca states that "No mention of sources or possible conflicts of interest" (MediaDoctor: Rating information, retrieved 29 Jan. 2009) is unacceptable in all relevant categories (Diagnostic Test, Harm Stories, Other, Pharmaceutical, Surgical Procedure). However, mentioning or identifying information sources is not the same as providing enough information about the sources that they can be easily accessed.

How difficult is it to include the journal issue and volume? Since more and more medical research is becoming freely available thanks to open access initiatives, why not go so far as to include a link to the full text? And if it is as yet unpublished shouldn't that be mentioned too?

I am continually emphasizing to patients and their families the importance of evaluating consumer health information resources, and one of the most important criteria is precisely: does the resource cite its sources? The HonCode lists this as number four out of eight principles that need to be followed in order to be certified. The National Cancer institute lists it fifth on its list of criteria, and the American Medical Library Association lists it third.

When will news media be held to the same principles?

*Speaking of citing your sources, to be honest I'm not sure how to cite something that I wrote in a Facebook post. If anyone can tell me I'd be glad to know. In any case my comment was posted on at 8:14am January 28.

About Info.Rx

Update:

In the fall of 2008 a Clinical Medical Librarianship component was added to the service. The librarian now acts as a resident supervisor in the teaching rooms at the clinic one half-day per week, providing support for clinical decision-making in addition to continued support for patient education.

The service is based on an innovative InformationRx model first implemented in the UK (see: Early experience of thecontribution of an information specialist within a primaryhealthcare team: a partnership venture betweenlibrary and healthcare services, doi: 10.1177/0961000604048915].

This model sees the information professional acting as a member of the health care team by providing informational/instructional support for patients/families and health professionals at point of care. Support for the service is provided by the main hospital library and is vital for ensuring long term sustainability.

The information professional is available 7 hrs per week to consult with patients/families that are in need of health information.

Health staff are encouraged to write InformationRx for patients which can then be filled by the information professional. Consultations with patients are treated as clinical encounters and are documented in the charts. The service has a clinic in the Centre's appointment scheduling software.

Patients and family members are welcome to drop in, or to submit questions by phone or email at their convenience. They can schedule appointments by contacting the information professional directly or by calling their team coordinator.

The library provides support by welcoming questions from patients and their families when the coordinator is not available. Herzl patients and families are able to borrow books from the Patient and Family Resource Centre's (PFRC) print collection, and a family medicine section has been created on the PFRC website which provides links to reliable and up-to-date consumer health resources.

Author"s note

Important: While based on real consultations, the cases posted in this blog have been mashed up, fictionalized, posted out of sequence, and otherwise tinkered with in order to maintain the privacy and comfort of the parties involved.

Also, the views and opinions expressed in this blog are strictly my own and do not necessarily reflect those of my employers.

About this blog

The Patient health Information Service at Herzl (H-PHIS) opened its doors in early July of this year (2007) and is in the early developmental stages. The challenges faced by myself (the service's coordinator), the staff, and the health care team at the HFPC are many and varied, as is to be expected when implementing a new and innovative service.

Perhaps the most unique aspect of the InfoRx model is the presence and participation of the information professional/librarian at point of care. This new and multidisciplinary approach presents a distinctive challenge. Health and support staff are not always clear on what knowledge and skills a librarian brings to the team. Conversely, I must be able to recognize and adapt to the needs and character of the community and of the setting itself.

This blog was created in response to some very astute and constructive criticism. After presenting to the residents at their weekly rounds, I was approached by one of the partners at the clinic who suggested that rather than introducing myself and the service and then explaining how to use it, it would have been more effective to present some cases illustrating what the service has to offer to the residents and to their patients. I see this as a perfect example of the kind of disconnect that can happen when two very different professions come together. In essence I had presented the way I would have to my own professional colleagues, but this was not the most appropriate approach given my audience.

After giving it some thought it occurred to me that it could be useful, both for myself and the rest of the team, for me to present a weekly case here, and talk about some of the challenges we are faced with and how these might best be resolved. Hopefully this will introduce some transparency to the InfoRx process.

This is meant to serve as a record of, and forum for discussion about, our challenges and successes. It is hopefully also an opportunity for other information professionals to be inspired by one example of what can be accomplished outside of the library setting.

About Me

Francesca Frati has an MLIS from Dalhousie University and is the wearer of many interconnected professional hats. She works at the SMBD Jewish General Hospital Health Sciences Library (HSL) as Patient Information Specialist and Instruction Librarian, at the Herzl Family Practise Centre (HFPC) as Patient Information Coordinator, and in her spare (work) time provides research support for physicians.
Francesca is a member of the advisory committee for the Society of Teachers of Family Medicine (STFM) Conference on Practise Improvement: "Blueprint for the Medical Home".